AB0946 Pelvis radiography findings and progression rates in patients with Psoriatic Arthritis under biologic treatment
Authors: G. Ayan, A. Sadic, L. Kiliç, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PsA) is a heterogenous disease that can present with various musculokeletal manifestations. Several studies have assessed the rate of sacroileitis in PsA population, however data on the involvement of other pelvic structures that may cause symptoms, such as major entheseal or hip involvevement, and progression rates during follow-up is scarce. Objectives This study aimed to understand overall pelvis radiography findings and progression rates during follow-up in a cohort of patients with PsA under biologic treatment. Methods PsA patients from the Hacettepe University biological database (HUR-BIO), were retreospectively analyzed for their pelvis radiographs. All radiographs for individual patient were consecutively scored. Modified New York (mNY) criteria was used to assess sacroileitis and ischium/ iliac wing/ greater-lesser trochanteric enthesopathy and symphysis pubis osteitis assessments were done using a grade 0, no changes, 1, minimal changes and grade 2 and more counted as significant changes (1). Hip involvement was scored using BASRI-hip score and data on prosthesis were noted (2). All of the assessments were done by an experienced rheumatologis (UK) and in cases with suspicion, another experienced rheumatologist reviewed the cases (LK) and a consensus was reached. Results Overall 273 patients (69.6% of females) with the mean (SD) age at the time of first radiography 43.3 (12) years were included. At their initial radiographic assessment, the median (IQR) PsA duration was 2 (7) years. Baseline radiographs showed 10 (%3.7) of the patients had transitional vertebra and 137 (50.2%) patients had sacroiletis according to mNY criteria. From patients without sacroileitis (n=136), 67 patients had following radiographs. After a mean (SD) 47.1 (37) months, 16 (23.8%) of them progressed to sacroiletitis according to mNY criteria. Regarding the major enthesopathies, Regarding significant changes, 26.8 % of the patients had ischium enthesopathy, 19.3% of the patients ad symphysis pubis involvement and 13.2% of the patients had iliac wing enthesopathy. Trochantor major enthesopathy rates were 2.4% and 1.4 % at right and left sites respectively. Only one patient had trochanter minor enthesitis on the left site (Table 1). Prosthesis requirement was observed in 4 hip joints and 4 hip joints had prosthesis. There was no correlation between meeting mNY criteria and having iliac, ischium, and pubis involvement ≥ 2. On the other hand, patients with when there is ischium enthesopathy ≥2 (17/46 (36.9%) vs 18/96 (18.7%), p=0.013) or iliac wing enthesopathy ≥2 above (10/18 (55.5%) vs. 26/129 (20.1%), p=0.001), any syndesmophyte in the spine is more commonly seen. Table 1. Distribution of major entheseal involvement and BASRI-hip socres and progression rates Location Grades First assessmentN (%) Progression rate* Ischium (n=164) 4 0 9/65 (13.8) 3 11 (6.7) 2 33 (20.1) 1 74 (45.1) 0 46 (28) Symphysis Pubis 4 0 8/78 (10.2) (n=191) 3 5 (2.6) 2 32(16.8) 1 60 (31.4) 0 94 (49.2) Iliac wing 4 0 3/72 (4.1) (n=174) 3 9 (5.2) 2 14 (8.0) 1 28 (16.1) 0 124 (71.3) BASRI score 4 3 (1.4) 0 (right) 3 2 (0.9) (n=220) 2 1 (0.5) 1 0 0 214 (97.3) BASRI score 4 0 0 (left) 3 4 (1.8) (n=219) 2 2 (0.9) 1 0 0 213 (97.3) *Defined as one unit increase in the grade Conclusion Half of the patients with PsA requiring advanced treatment modalities, had sacroileitis in a median 2 years of disease duration and the rest may progress to sacroileitis during the follow-up period. Major enthesopathy involvement was also seen in more than half of the patients. Ischium, iliac wing enthesopathies and spinal syndesmophytes may be all a part of the osteoproliferative process. Further assessment is needed to correlate those radiographic changes to clinical symptoms. References [1]van der Linden S, et al. Arthritis Rheum. 1984 Apr;27(4):361-8. [2]Calin A, et al. J Rheumatol 1999;26:988-92 Disclosure of Interests None declared